April 23, 2024

Could you be a candidate for cervical disc replacement?

Texas Health Center for Diagnostics and Surgery

If you're experiencing neck and upper back pain, cervical disc replacement may be the right fit for you. Dr. Jessica Shellock, a spine surgeon on the medical staff at the Center for Disc Replacement, provides insight into candidacy criteria, procedure insights, and associated risks.

Categories: Back Pain Disc Replacement Dr. Jessica Shellock Spine Surgery

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For patients experiencing pain in the neck and upper back, cervical spine artificial disc replacement surgery may be an option for relieving pain and restoring range of motion. Whether you’re a candidate for cervical disc replacement, however, is a complicated question to consider in consultation with your physician or surgeon.

Most patients should at least consider cervical disc replacement, especially before proceeding with spinal fusion surgery, according to Dr. Jessica Shellock, a spine surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery (THCDS) in Plano, Texas and co-director of the Center for Disc Replacement.

“If you've been told that you are a candidate for a spinal fusion in your neck, you really should at least get the opinion of somebody who does disc replacement to see if you're a candidate for that instead,” said Dr. Shellock.¹

Who’s a Good Candidate?

Typically, a patient who’s a good candidate for cervical disc replacement surgery will have single- or two-level degenerative disc disease. That means the problem area affects one or two vertebrae.

“Generally, that's going to also involve some amount of nerve compression and maybe some spinal cord compression,” said Dr. Shellock. “Symptomatically, patients will generally present with neck pain and a combination of arm numbness or pain, and sometimes there are even neurologic findings like weakness.”

In most cases, surgery isn’t recommended until other treatments, such as physical therapy and medication, have been tried without success.

Imaging, such as a CT scan or MRI, helps the surgeon to determine whether sufficient space is available between the affected vertebrae so that an artificial disc can be mobilized.

“Unfortunately, if there's really advanced degenerative changes, you might not be a candidate to restore motion at that level,” said Dr. Shellock. “We also make sure that there's not any type of instability where the spinal segments are moving in an abnormal manner. If that’s the case, if we put in a device that keeps moving, that could exacerbate the problem.”

How Cervical Disc Replacement Works

Healthy discs act as flexible cushions between the vertebrae (bones) of the spine. In the upper back, or cervical spine, these discs allow the neck to bend and rotate.

As we get older, wear and tear can cause the disc to thin or herniate – bulging outside of the space between the vertebrae– resulting in pinched nerves and pain. Artificial disc surgery replaces a worn-out disc in the spine with a device that moves like a natural disc.

In cervical disc replacement surgery, the surgeon enters through a small incision from the front of the neck.

“When you're asleep and positioned on the operating table, we have to move a couple of structures, namely the trachea, the tube that we breathe through, and the esophagus, the tube that we swallow through, to allow access to the disc space,” Dr. Shellock added.

Next, the damaged disc is removed. Typically, pins are inserted in the surrounding bones, allowing the surgeon to open that space and restore the height of the disc to accommodate the replacement disc.

“Once all of that is done, we then determine the best fit for the implant that we're using,” said Dr. Shellock. “There are trials that allow us to size the implant and determine how it's going to fit in your disc space so that we can make the best choice. Some of the devices require a little bit of an additional prep step, meaning that we have to make some cuts in the bone to help guide the implant into the space.”²

Once the implant is in place, surgeons close the incision, and the patient is taken to the recovery unit.

Usually, the surgery takes about an hour for one-level and about two hours for two-level surgery.

Cervical Disc Replacement Risks

Is disc replacement surgery safe?

Of course, any type of surgery involves some risk. The potential for cervical disc replacement risks should be discussed with your surgeon.

“For the most part, the risk potential for these side effects is very low,” said Dr. Shellock.

Hoarseness after surgery is one of the possible disc replacement surgery risks.

“Because we have to move other structures – the trachea, the esophagus -- out of the way to get access to the spine, there is a slight risk that one of those could be injured, which could lead to hoarseness,” said Dr. Shellock.

A significant number of patients do experience some difficulty in swallowing temporarily after the procedure.

“Sometimes it's scary if you wake up and you feel like you're not swallowing as well as you should,” said Dr. Shellock. “However, that usually returns to normal fairly quickly.”³

These risks, of course, must be weighed against the expected benefits. For many patients, cervical disc replacement surgery relieves or eliminates their pain, and helps them return to normal functioning.

“Many patients do find relief,” said Dr. Shellock. “This is a really gratifying operation for the patient and the surgeon.”